Located in the Himalayan Mountain range, where iodine deficiency has long been endemic, Nepal was one of the first countries in the South Asia to recognize the magnitude of the problem and develop a comprehensive program to prevent iodine deficiency disorders. This program has evolved over the past 45 years and is now seen as one of the most successful in the world, providing a model of how to use data to refine the program design to achieve and sustain optimal iodine nutrition.
In the 1960s, studies in Nepal revealed a high prevalence of goiter and many cases of cretinism, the most profound consequences of a lack of iodine in the diet. Soon after these data were revealed, Nepal began the distribution of iodized salt which was imported from India by the Nepali Salt Trading Corporation. Nepal also implemented iodized oil supplementation program in hyper-endemic districts where access to iodized salt was very limited. These combined efforts improved iodine nutrition significantly and resulted in the disappearance of visible goiter by 1998. From 1998 onwards, an intensified salt iodization program became the exclusive strategy to improve iodine intake and combat iodine deficiency disorders in the country.
The program introduced a number of innovative initiatives, including a strong bilateral partnership between the Governments of India and Nepal, increase in iodization level at production points, a broad campaign to increase an awareness about the importance of iodized salt, a shift in consumer demand from large crystal salt to a more refined product, as well as enhanced packaging which minimizes iodine losses in salt during the transportation, storage and distribution.
Through these activities, there has been tremendous progress and now more than 90% of households have access to adequately iodized salt. This has resulted in optimal iodine nutrition among women of reproductive age and pregnant women, but also borderline excessive iodine intake among school aged children particularly in urban areas and the Terai region.
Informed by critical program monitoring data, the Government of Nepal examined the standard for the iodine content in salt (which was increased in late 1990s) and realized that it was necessary to decrease the level of iodine in iodized salt to meet the needs of the population and not pose any risk of excessive intake. Moving forward, these recommendations will lead to a revision in the legislation of mandatory salt iodization in the country, and ongoing monitoring will track the performance of the program and assess the impact of these changes on the iodine status of the population.
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